Patterns of distant metastases in vulvar cancer

- Distant metastases is a rare event in vulvar cancer (5.1%)
- Tumor diameter, invasion depth, nodal status, number of metastatic lymph nodes were predictive for occurrence of metastases
- Median survival from first diagnosis of metastases was 5.6 months
- 2 year overall survival rate after diagnosis of distant metastases was 11.3%

ObjectiveMetastatic vulvar cancer is a rare disease. Information on metastatic patterns and corresponding prognosis or therapeutic approaches is scarce. We therefore analyzed pattern and course of metastatic disease in a large single center cohort.MethodsAll patients with primary squamous-cell cancer of the vulvar [n = 391, median age: 60 years (range 20-94)] treated at the Gynecological Cancer Center Hamburg-Eppendorf 1996-2013 were retrospectively evaluated for occurrence of distant metastasis. Furthermore, a systematic Medline database search was performed using the terms: 'vulvar cancer' AND 'metastasis', 'chemotherapy', 'patterns of recurrence', or 'prognosis'.ResultsOut of 391 patients with primary squamous cell vulvar cancer, 20 patients (5.1%) eventually presented with distant metastases. In these 20 patients, median time to first diagnosis of metastasis after primary diagnosis was 13.4 months (range 4-104). Often patients experienced one or more local recurrences before distant spread (12/20, 60.0%). Documented metastatic sites were lung (n = 9), liver (n = 7), bone (n = 5), skin (n = 4) and lymph-nodes (axillary/thoracic/paraaortic, n = 3). The majority of patients presented with unilocal metastases (13/20, 65.0%). In univariate analysis tumor diameter, invasion depth, nodal status and number of metastatic lymph-nodes were identified predictive for occurrence of distant metastases. 2-year-overall-survival-rate after metastases of all metastatic patients was 11.3%; median survival from first diagnosis of metastases was 5.6 months.ConclusionThe occurrence of distant metastasis from vulvar cancer is a rare event with very limited prognosis. Further efforts, especially translational research will be crucial to identify prognostic markers as well as therapeutic targets to improve survival in these patients.